Welcome Network Providers
Please use this portal for fast and secure document submissions such as claims, invoices, medical reports, W9s, signed LOAs, EFTs, etc., to our Provider Relations Department. Simply select the item from the list below and complete the electronic form. If you have questions or need assistance, please contact our Provider Relations Team at 866.888.6724 or firstname.lastname@example.org.
To inquire about the status of an existing claim, please email email@example.com.
Security notice: This portal is secured and compliant with HIPAA. A confirmation email will be sent upon form submission, but no PHI will be sent in the confirmation.